The diagnostic frequency of multiple pulmonary tumor nodules has increased significantly in clinical practice. Among patients with multiple pulmonary nodules, distinguishing between separate primary lung carcinomas and intrapulmonary metastases is critical for accurate tumor staging, therapeutic decision-making, and prognostic evaluation. The consensus document "Differentiating separate primary lung adenocarcinomas from intrapulmonary metastases with emphasis on pathological and molecular considerations: Recommendations from the International Association for the Study of Lung Cancer Pathology Committee" highlights the pivotal role of integrated pathological and molecular analyses in diagnosing and differentiating primary lung adenocarcinomas from intrapulmonary metastatic lesions. It further proposes a combined four-step histologic and molecular classification algorithm for addressing multiple pulmonary tumor nodules of adenocarcinoma histology, providing clinicians with enhanced diagnostic tools to refine staging accuracy, guide therapeutic strategies, and improve prognostic predictions for lung adenocarcinoma. Building on current advancements in global research, this article offers a comprehensive interpretation of the consensus recommendations.
Objective To assess the diagnostic value of MRI and Bone Scan (BS) for osseous metastases in patients with breast cancer. Methods The trials were searched from PubMed, EMBASE, Cochrane Library, CBM, CNKI and VIP; the Criteria for inclusion and exclusion were based on the standard for diagnosis tests. Meta-Disc software (Version 1.4) was used for data analysis; and the area under curve (AUC) of SROC was calculated. Results A total of 5 researches involving 329 patients were included. The sensitivity of MRI and BS were 0.99 (0.97, 1.00) and 0.93 (0.88, 0.97) respectively; the specificity for MRI and BS were 0.99 (0.95, 1.00) and 0.86 (0.79, 0.92) respectively; and the AUC of SROC curve for MRI and BS were 0.993 6 and 0.967 5 respectively. Conclusion MRI can be regarded as an effective and feasible method for osseous metastases in breast cancer.
ObjectiveTo analyze the influence of different surgical methods on survival and relapse-free survival in colorectal liver metastases. MethodsClinical data of 71 cases of colorectal liver metastases who treated in PLA General Hospital from January 2002 to may 2013 were collected retrospectively, to analyzed the effect of different surgical methods on survival and relapse-free survival of this kind of cases. ResultsAll of primary lesions underwent radical resection. And for the liver metastases, 20 cases didn't received any intervention (non-intervention group), 20 cases underwent resection of liver metastases, 20 cases underwent radiofrequency ablation, and 11 cases underwent radiofrequency ablation and resection of liver metastases (all 61 cases who received intervention were classified to intervention group). Results of Cox proportional hazards model showed that, in the condition of controlling other confounding factors, intervention can improve the survival (HR=1.724, P=0.043) and relapse-free survival (HR=0.701, P=0.048) of cases of colorectal liver metastases, cases who received intervention had better survival situation and the relapse-free survival situation. ConclusionFor cases of colorectal liver metastases, in condition of radical operation for colorectal cancer, the intervention for liver metastases can prolong the survival time and relapse-free survival time.
Objective To determine the efficacy of radioisotopes to control metastasic pain in patients with tumor bone metastases and complications due to bone metastases (hypercalcaemia, bone fracture and spinal cord compression). The effectiveness of radioisotopes in relation to patient survival and adverse effects were also assessed. Methods MEDLINE (1966 to April 2005),EMBASE (1966 to April 2005), The Cochrane Library (Issue 1, 2005) and CBMdisc (1979 to April 2005) were searched for randomized controlled trials (RCTs). Data were extracted by two reviewers using a designed extraction form. The quality of included RCTs was critically assessed. RevMan 4.2 software was used for data analysis. Results Four RCTs were included. The results of meta-analysis showed that small dose of radioisotopes couldn’t control metastatic pain in short term(2 months) with relative risk (RR) 1.13, 95%confidence interval (CI) 0.34 to 3.76, but large dose can significantly control metastatic pain in medium term(6 month) with RR 1.90, 95％CI 1.23 to 2.92; no evidence was available to assess long term(≥12 months) effects. No study provided data on quality of life, mortality, bone metastatic complications (hypercalcaemia, bone fracture) and analgesic use etc. Leukocytopenia and thrombocytopenia were secondary effects associated with the administration of radioisotopes. The incidences of leukocytopenia and thrombocytopenia were significantly greater in patients treated by radioisotopes with RR 8.28, 95％CI 2.24 to 30.67, and RR 3.70, 95％CI 1.59 to 9.04, respectively. Conclusions There is some evidence indicating that large dose of radioisotopes can relieve metastatic bone pain over one to six months, but adverse effects, particularly leukocytopenia and thrombocytopenia, have also been experienced.
ObjectiveTo study the preventive effect of zoledronic acid on the bone metastases of breast cancer. MethodsFour hundred and eighteen female patients with infiltrating ductal carcinoma who were underwent surgery in The First Affiliated Hospital of Xinjiang Medical University from Jan. 2006 to Dec. 2009 were collected and divided into 2 group, patients of prevention group accepted the preventive remedy of zoledronic acid(n=216), but patients of control group didn't accept(n=202). Comparison of incidence of bone metastases and recurrence was performed. ResultsThere were 37(17.13%) patients suffered bone metastases in prevention group and 73(36.14%) patients in control group, so the incidence of bone metastases was higher in control group(χ2=19.45, P<0.05). But there were no significant difference on incidence of pulmonary metastasis, liver metastases, other parts of metastases, multiple organ metastases, and recurrence(P>0.05). ConclusionZoledronic acid could significantly reduce the incidence of bone metastases for patients with breast cancer, who underwent chemotherapy of conventional dose after operation, and it can effectively improve the prognosis of patients with breast cancer.
According to the inclusion and exclusion criteria, we searched for relevant original articles in some big Chinese and English databases.The qualities of the studies were evaluated with QUADAS quality assessment tool. A software program, Meta-disc, was used to obtain the pooled estimates and heterogeneity test for sensitivity, specificity, SROC curve, and so on. Finally the 17 article were included. On a per-patient basis, the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), Q*, SROC area under curve for 99mTc-MDP bone scan and computed tomography (CT) were 0.87 and 0.99, 0.81 and 0.98, 3.88 and 13.86, 0.2 and 0.03, 27.73 and 612.17, 0.8418 and 0.9732, 0.9097 and 0.9952, respectively. On a per-focus basis, the pooled SEN, SPE, LR+, LR-, DOR, Q*, SROC area under curve for 99mTc-MDP bone scan was 0.86, 0.97, 13.32, 0.16, 102.4, 0.8944, 0.9528, respectively. For CT, only 1 article were included. This paper demonstrate: whether 99mTc-MDP or CT both have high diagnostic efficiency for bone metastase of breast cancer.
Abstract：Pulmonary metastasectomy is an important curative option for patients with osteogenic and softtissue sarcoma spread to the lungs. Complete surgical removal of pulmonary metastases can improve survival and is recommended under certain criteria. Specific issues that require consideration when planning pulmonary metastasectomy include: preoperative assessment of the operation index and contraindications, choice of surgical strategies, pulmonary parenchymal preservation, and the role of lymphadenectomy. With the development of iconography and chemotherapy, the emergence of targeted drugs, and the innovation of radiotherapy, the concept of the diagnosis and treatment for pulmonary metastases from osteogenic and softtissue sarcoma is also undergoing great changes.
Objective To improve the knowledge of pulmonary benign metastasizing leiomyoma.Methods A case of pulmonary benign metastasizing leiomyoma diagnosed in the First Affiliated Hospital of Nanjing Medical University was analyzed.Results A 32-year-old woman suffered from chest stuffiness,heavy pant and weakness after myomectomy in amonth. Chest CT showed miliary shadowwas diffused in both sides of her lungs, but serumtumor marker was normal. When the chest CT result did not change significantly after four-week’s anti-tuberculosis treatment, the patient accepted lung biopsy by thoracoscopic surgery. HE staining showed that the tumor cells had characteristics of smooth muscle cell differentiation.Immunohistochemical staining showed a low proliferation index of tumor cells, which did not indicate theexistence of pulmonary malignant tumor. Smooth muscle actin ( SMA) and desmin as the specific markers of smooth muscle, estrogen receptor ( ER) and progesterone receptor ( PR) were all bly positive, which was the characteristic of pulmonary benign metastasizing leiomyoma. The patient was given the anti-estrogen tamoxifen for 3 months.Without radiological evidence of disease development and further distant metastasis,the patient had been followed up. Conclusions Pulmonary benign metastasizing leiomyoma is a rare disease which can occur in any age group, particularly prevalent among late childbirth women. All patients have uterine leiomyoma history and/ or myomectomy operation, often associated with uterine metastasis, which commonly occurs in lung.
This paper is aimed to assess the diagnostic value of MRI versus 99Tcm-methylene diphosphonate (99Tcm-MDP) bone scan (BS) for osseous metastases in patients with prostate cancer. The computer-based retrieval was conducted on PubMed, EMBASE, EBSCO, Web of Knowledge, the Cochrane Library and Ovid data bases to search for trials about diagnosing osseous metastases of prostate cancer with MRI and 99Tcm-MDP BS. Selected with time acceptance and time exclusion criteria, the data quality were evaluated with QUADAS quality assessment tool and collected. We used the Meta-Disc software to conduct meta-analysis, and then calculated the pooled sensitivity, specificity and diagnostic odds ratio (DOR), drew the summary receiving operating characteristic (SROC) curve, and measured the area under curve (AUC) and Q* value. Then five studies were included, involving 353 patients. The pooled sensitivity of MRI and BS was 0.95 (95% CI 0.90~0.98) and 0.67 (95% CI 0.58~0.75), respectively. The pooled specificity was 0.97 (95% CI 0.94~0.99) and 0.88 (95% CI 0.83~0.91), respectively. The pooled DOR was 402.99 (95% CI 119.05~1 364.15) and 23.85 (95% CI 1.32~431.48), respectively. The AUC was 0.990 1 and 0.624 1, respectively. The Q* was 0.958 7 and 0.593 8. It can well be concluded that MRI is more effective than 99Tcm-MDP BS in the diagnosis of osseous metastases in patients with prostate cancer.
Spine is a common site of metastasis in patients with malignant tumors, and tumor metastasis to the spine can lead to pain, pathological fractures, and nerve compression. In order to optimize the diagnosis and management of patients with spinal metastases and metastatic spinal cord compression (MSCC), the National Institute for Health and Care Excellence (NICE) in the UK proposed the first diagnostic and treatment guidelines for patients with MSCC (or at risk of MSCC) in 2008. In recent years, with the rapid advancement of spinal surgery and radiotherapy technology, the standardized process of MSCC diagnosis and treatment urgently needs to be updated. In 2023, NICE launched new guidelines for spinal metastases and MSCC. Based on a thorough study of the guidelines, this article discusses and interprets pain management, corticosteroid treatment, application of bisphosphonates and denosumab, tools for assessing spinal stability and prognosis, radiation therapy, surgical timing and approach, etc., providing reference for clinical diagnosis and treatment in China.